Toronto centre shutters youth gender clinic

Dr Kenneth Zucker no longer part of centre

The Centre for Addiction and Mental Health, pictured here in December 2014, will close its Gender Identity Clinic after an external report detailed instances of ethical lapses and questionable practices. Credit: CAMH/Facebook

The Centre for Addiction and Mental Health (CAMH) will close its Gender Identity Clinic (GIC) for children and youth after an external review denounced the clinic for being out of touch, engaging in serious ethical lapses and utilizing practices that verged on reparative therapy.

In addition, Dr Kenneth Zucker, the head of the GIC and a hugely controversial figure among transgender rights advocates, is no longer with CAMH, according to Dr Kwame McKenzie, medical director for underserved populations at CAMH.

The GIC won’t be accepting any new patients, and current patients will slowly be phased out of the clinic.

The report that sparked this shift was commissioned by CAMH after the Rainbow Health Alliance raised concerns that its GIC might be practicing “conversion therapy,” which has been illegal to conduct on children since June 4, 2015, in Ontario.

The report argues that the clinic was stuck in the past when it came to dealing with gender-variant youth.

“The research knowledge and clinical guidelines have evolved and society’s understanding and acceptance of the diversity of gender expression and identity have changed, but GIC’s approach has not,” the report states.

‘Hairy little vermin’

Released in its entirety by CAMH, the 29-page report details allegations of how the GIC appeared to practice reparative therapy, often did not act in the best interests of its patients and reported instances when clinicians were dismissive and sometimes abusive toward their patients.

“We cannot state that the clinic does not practice reparative approaches (if not outright therapies) with respect to influencing gender identity development,” it states.

Former patients detail numerous instances where they felt uncomfortable or even seriously intimidated by the GIC’s practices and by Zucker in particular.

One former patient, who is now an adult trans man, alleges that Zucker “asked him to remove his shirt in front of other clinicians present, laughed when he complied, and then referred to him as a ‘hairy little vermin.’”

Other patients describe being “poked and prodded” and being subjected to unnecessary personal questions about sexual fantasies.

The investigators describe an instance of a nine-year-old child being “asked what made him sexually excited during his first meeting with a clinician in the initial assessment.”

Doctors would allegedly take photos, sometimes with cell phones, of patients without explanation or consent.

The report goes on to detail medical decisions that were improperly influenced by how comfortable a child’s parents were with their gender identity. Patients and families would also rarely be directed toward community resources that could help them. In another case, one child, who was reportedly no longer experiencing gender dysphoria, was allegedly directed to “spend more time with cisgendered boys because he had effeminate speech and mannerisms.”

The report suggests that clinicians appeared to operate on an assumption of “heterosexual cisgender as the most acceptable treatment outcome,” and that many patients felt intimidated by Zucker, to the point where they felt they couldn’t raise concerns or ask questions.

Going forward

“As a clinician and also as a parent, hearing those sorts of comments and reading those sorts of testimonies is quite disturbing,” says Dr McKenzie. “For any person who is in that situation you would want to apologize as a clinician.”

McKenzie says that early next year, CAMH will begin consultations with the broader community about how to approach the issue of gender identity among young people.

According to McKenzie, the consultations will be broad and will seek to include the trans community, former patients, Rainbow Health Alliance, other hospitals, academic institutions and any other stakeholders.

“Our review says there are issues that have to be dealt with,” he says. “Now let’s make a plan going forward so that we’ve got something that works for this vulnerable population.”

“I think if anybody is worried we were not serious about this, that we were not trying to be credible and honest in our approach, they can see from the transparency,” says McKenzie, “that we are serious about being part of the solution here.”